Provider Demographics
NPI:1649341454
Name:RUDER, DORIS L (APNP)
Entity type:Individual
Prefix:
First Name:DORIS
Middle Name:L
Last Name:RUDER
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7520 US HIGHWAY 51 S
Mailing Address - Street 2:
Mailing Address - City:MINOCQUA
Mailing Address - State:WI
Mailing Address - Zip Code:54548-9202
Mailing Address - Country:US
Mailing Address - Phone:715-358-1911
Mailing Address - Fax:715-358-1912
Practice Address - Street 1:7520 US HIGHWAY 51 S
Practice Address - Street 2:
Practice Address - City:MINOCQUA
Practice Address - State:WI
Practice Address - Zip Code:54548-9202
Practice Address - Country:US
Practice Address - Phone:715-358-1911
Practice Address - Fax:715-358-1912
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1278-033363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1052540001OtherDMERC NUMBER
WI43878900Medicaid
WI43878900Medicaid